“Two-thirds of adults and one-third of children are overweight or obese. Left unchecked, obesity’s effects on health, health care costs, and our productivity as a nation could become catastrophic.

The staggering human toll of obesity-related chronic disease and disability, and an annual cost of $190.2 billion for treating obesity-related illness, underscore the urgent need to strengthen prevention efforts in the United States. The Robert Wood Johnson Foundation asked the IOM to identify catalysts that could speed progress in obesity prevention.

The IOM evaluated prior obesity prevention strategies and identified recommendations to meet the following goals and accelerate progress

• Integrate physical activity every day in every way
• Market what matters for a healthy life
• Make healthy foods and beverages available everywhere
• Activate employers and health care professionals
• Strengthen schools as the heart of health

On their own, accomplishing any one of these might help speed up progress in preventing obesity, but together, their effects will be reinforced, amplified, and maximized.”

Related posts:

1. “Better than a BMI? New obesity scale proposed”

By: Paul Lee from Ask Smile Artistry

When it comes to your dental health, cavities that are left untreated can lead to plenty of other more serious unrelated issues. In order to avoid problems like cavities, there are plenty of things that you should take into account. Here are some myths and facts in regard to your dental health that you should understand.

Sugar is the Main Cause of Cavities

This point is partly myth and fact. Cavities are caused by the acid that is produced by the bacteria located inside of your mouth. However, these bacteria consume carbohydrates, including sugar. When anything with carbohydrates is eaten, the bacteria inside your mouth become active and produce more acid that can eat into your tooth. In any case, every time you consume carbohydrates you should ensure a good cleaning and mouthwash.

Acidic Foods Cause Tooth Decay

This is a fact. Foods that are high in acid such as fizzy drinks, citric juices, and lemons, may not cause cavities, but they can cause damage to the enamel of your teeth. Acid causes the enamel of your teeth to erode, which will make the tooth weaker eventually causing decay. If they are left further untreated, then the tooth could require extraction or a root canal to be sorted.

All Fillings will have to be Replaced

This is a dental myth. If a filling breaks down or the tooth gets a cavity, the filling may need to be replaced. However, as long as the tooth remains healthy, there is no reason that a filling cannot last for a lifetime. Fillings have been formed from such strong material that this is no longer an issue.

You will Know if you have a Cavity

This is a myth, and a bad one at that. When mild tooth decay starts, there are often no noticeable symptoms. Some people may experience mild pain but may put it down to sensitivity. When a cavity is painful, it is because the decay of the tooth has become so far advanced that it has caused damage to the nerve. When tooth decay is allowed to advance this far, it can lead to further dental health problems, and expensive procedures may become necessary such as an extraction or root canal. This is one of the biggest reasons why it is so important to see your dentist for regular checkups every six months.

These are just a few of the myths and facts that many people have heard about their oral health. There are many myths about dental health, and it is important to learn the facts from your dentist. Keeping your teeth healthy is crucial as poor oral health can lead to a host of other more serious health issues as well.

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I had wonderful privilege to interview a fellow colleague – Younis Salmean, PhDc, M.S.- who has been doing research with fiber and the impact of fiber supplementation to patients with chronic kidney disease.  Born in Kuwait, Mr. Salmean came to the United Stated in 2001 to get an undergraduate education in Food Science and Dietetics at Fresno State University, California. He enjoys and has worked in many health care settings related to nutrition care and education in private and public clinics. Mr. Salmean has worked with clients that with various health needs; ranging from controlling diabetes, cholesterol and weight loss (which by far was the most popular reason to be seen) to wellbeing and performance. Additionally he was fortunate to have worked as a teaching assistant for about 6 months under Dr. Fatima Huffman (the chair at the Department of Nutrition at FIU), who was on sabbatical in Kuwait. Dr. Huffman took Mr. Salmean under her wing, benefiting from her experience in diabetes and public health care. She had him focus at looking up research in diabetes, which has been one of his many interests. Soon after, he joined the department of Food Science and Human Nutrition at the University of Florida.

PHBugle: Thank you for taking the time to interview with the Public Health Bugle. So here at the University of Florida, what is the focus of your research and the importance?

Younis: I was initially involved in working on the link between folate, vitamin B12, polymorphisms and risk of congenital hear defects. I was very fortunate to have worked with the world renowned folate expert professor Lynn Baily. After getting my master degree, I developed great interest in fiber’s therapeutic benefits. That led me to working with Dr. Wendy Dahl on fiber and its role and potential benefit in uremia management. This transition to fiber therapy was important because I enjoyed working more on applied nutritional theories.  There is some evidence that suggests fiber therapy may potentially be beneficial for patients with chronic kidney disease (CKD. She liked the idea and we moved from there, which is now my area of research – fiber therapy in chronic kidney disease patients.

PHBugle: What is the difference between chronic kidney disease and kidney failure?

Younis: CKD is divided into 5 stages: stage one being the mildest decline in kidney function, while stage five would be more sever and would require dialysis or transplant (kidney failure). Patients who become diagnosed with kidney failure or stage 5 CKD suffer a lot more symptoms and significant reduction in quality of life compared to those in stage 3 for example.

PHBugle: Did you experience a lot of chronic kidney disease patients in Kuwait?

Younis: It is prevalent especially with high incidence of diabetes and hypertension both of which are the leading causes for kidney failure. I didn’t work with this population in Kuwait, however, I did rotations in California and visited patients who were on dialysis;.The area I’m working in –preventative nutritional care – was right for me as it emphasize the important of therapeutic preventative care. In this case our target is to delay the progression of kidney disease and prevent or delay need for dialysis or transplant.

PHBugle: What is the prevalence of chronic kidney disease in the United States?

Younis: The guidelines provide a broader definition of what kidney disease encompasses. “CDC analyzed the most recent data from the National Health and Nutrition Examination Survey (NHANES). This report summarizes the results of that analysis, which determined that 16.8% of the U.S. population aged >20 years had CKD, according to 1999–2004 NHANES”. data. Kidney disease is measured by estimating glomerular filtration rate or eGFR, which is defined as:

“…a more accurate way to measure how well your kidneys filter wastes from your blood. Your GFR gives your doctor an idea of the speed at which your kidneys are failing, and whether you are at risk for complications of kidney disease. GFR can be estimated from serum creatinine.”

Most healthy people have a GFR of greater than 90, with children and the elderly having a lower GFR and kidney failure defined as a GFR lower than 15. Some individuals may have elevated GFR with some kidney damage or they have a GFR of 80-90 without evidence of kidney damage. Such individuals can live a normal life for several years before they develop signs and symptoms. In relation to U.S. population percentages, stage 1 and 2 (mild decline) represents about 10.8 % while more moderate and serious decline (stage 3) represents 5.4% Both stage 4/5 represents less than 0.5% of US population.

PHBugle: Could you walk us through your current research that was published and discuss the clinical implications.

Younis: In our study, patients were recruited who had CKD stages 3-5, but not yet on dialysis. We started with 17 patients and were able to successfully finish with 15 patients. The study was a 6 week trial, with 2 week control period (baseline measures with no fiber supplementation) followed by 4 weeks of fiber treatment. We provided a mixed fiber sources that patients incorporated into their daily diet (e.g., some insoluble and some soluble) and it was provided in commercially available cereal bars, cookies, and Kellogg’s™ Corn Pops®. The total amount of fiber in our treatment diet equated to 23grams/day aside from their normal diet.

PHBugle: Side note, how much fiber is recommended for most Americans?

Younis: For the general public, the Institute of Medicine recommends Americans to consume 14g/1000 calories (ranging from 21-38grams/day). No specific recommendation for chronic kidney patients, so this is one reason we conducted such a study. The actual fiber consumption in the U.S. is about 14-17grams/day, which falls significantly short of the recommendation.

CKD patients have restricted diet when it comes to phosphorus and potassium (which are typically associated with sources of fiber); and the fact that many symptoms, such as loss of appetite may also reduce their intake in general. On these bases, we hypothesized that CKD patients consumed less fiber than even the average 14-17grams/day. For example, in this study, patients were consuming about 11 grams/day of fiber. So right away, we took note of the lower fiber consumption in chronic kidney disease patients.

PHBugle: Did these patients receive a prescribed diet in addition to the fiber sources you provided?

Younis: This was an applied study. Meaning, we tried to limit our interference as much as possible, with the exception of the fiber containing foods we provided them that I mentioned earlier. Since we had no true control, we had a 2 week baseline period (our “control”) in which we provided closely matched foods but without fiber. We were able to see no difference in energy intake or difference in protein and carbohydrate intakes; however fat consumption during the 4 week treatment period was significantly reduced.

Overall, after the 6 week trial, we saw no difference in the patients’ blood markers after the initial 2 weeks; but after 4 weeks of treatment we saw a significant decline in their blood urea nitrogen (BUN) by 10%, a decrease in creatinine levels by 7.6%. Most notably, eGFR increased by 8.5%. This may suggest that after treatment, kidney function improved.

Our findings paved the road for potential nutritional therapy that may be important for CKD patients. Doctors and clinicians should be aware of such experimental therapy.

Because this was one study, no conclusive evidence can be made and therefore we decided to follow up with another study to look at these results s well as other markers. The second study will potentially give us more concrete evidence if it follows the same results, but we have to wait and see.

PHBugle: So what are the implications of these study findings?

Younis: The primary implication is that with the widespread availability of fiber and fiber products, CKD patients can now benefit from an affordable and effective therapy to lower uremic toxins (toxins in the urine) and even improve eGFR. If the fiber treatment is truly impactful, then fiber supplementation for kidney disease patients may delay the onset of dialysis. Our patients’ average eGFR at the beginning of the study put them in the stage 4 category – one stage closer to dialysis. At the end of the study, eGFR average was 31.5 which is stage 3 category – two stages away from dialysis.

One point I want to add is that we had measured quality of life through a validated questionnaire – Kidney Disease Quality of Life Questionnaire (KDQOL-36™) and found out that patients’ physical symptoms improved significantly. Patients reported a 5 point increase and that was very surprising and encouraging.  We couldn’t correlate these results with changes in blood uremic toxins due to small sample size, nevertheless these results are encouraging. We hypothesize that reduced uremic load (BUN and creatinine) may have contributed to these perceived improvement in physical health well-being as people started to feel better. Most researchers agree that on average, the quality of life score would be around 50 points for healthy individuals. So the score jumped from 30 to 35, which is considered significant.

PHBugle: Is this a study that is first of its kind?

Younis: To our knowledge, this is the first study to study these effects while using such a low amount of fiber in the diet (23 grams/day of prescribed fiber), with an actual average fiber consumption of 17 grams/day. Previous studies used anywhere between 40-50 grams/day. We believe the amount we used was more achievable. Also, our study had a novel finding of an improvement in eGFR (8.5%) after fiber treatment by bring creatinine down.

PHBugle: So, how do your findings apply to the general public?

Younis: There is a lot of evidence showing that populations consuming higher fiber than those who do not have significant improvements in overall cardiovascular health (represented by reduce blood markers of cardiovascular risk). Also, fiber benefits diabetics by attenuating glucose levels. Studies have also shown that the higher intake of fiber relates to lower overall bodyweight. However, fiber is complicated by the source. Population’s that consume a non-western diet, containing higher amounts of natural fiber (e.g., fruits and vegetables) and see improvements in overall health, raises the question if it’s the diet itself or the fiber that leads to improved health factors? However, studies that use fortified foods (e.g., supplementing the diet with a fiber source) or isolated fibers have clearly shown reduction in cholesterol levels which can explain improvements in cardiovascular health. Other benefits include improvement in colonic health and immunity through the action of one’s gut bacteria fermenting the fiber from the diet.

Thank you Mr. Salmean for your time! For additional information on the benefits of fiber, please refer to the following journal article – Health Implications of Dietary Fiber (J Am Diet Assoc. 2008;108:1716-1731):

Additional Resources:

1)     Prevalence of Chronic Kidney Disease (NHANES data) – http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5608a2.htm

2)     Study Abstract:  http://www.linkedin.com/pub/younis-salmean/35/49/3b

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Redefining Health Care Creating Value-Based Competition on Results

Review By: Ali Al-Rajhi, Editor of the Public Health Bugle

Authors: Michael E. Porter , Elizabeth O. Teisberg

Publisher: Harvard Business School Press

In Redefining Health Care, the authorsMichael Porter – an “internationally renowned strategy expert – and Elizabeth Teisberg – an “innovation expert”- present the underlying issues with the U.S. health care system.The authors’ argue that the health care industry focuses more towards reducing costs (e.g., cost-shifting, eliminating services, capitation, accumulate bargaining power) when their focus should be on creating value for patients. This in large is related to the style of competition known as Zero-Sum competition, which is a ‘win-lose’ approach to health care. The authors suggest an industrial move towards Positive-Sum Competition or ‘Value-Based Competition’ founded on one priority – patient value.

The data presented is very detailed and supportive of the authors’ arguments; however, the information, at times, becomes redundant leaving the reader wondering if the authors could make the same point with less examples. The book starts by addressing the scope of the U.S. health care problem, its root causes and where it went wrong. Then it defines the principles of a Value-Based Competition and how such a strategy can be applied to providers, health plans, suppliers, consumers, employers and the implications for the U.S. government.

Implicating a Value-Based Health System is not a farfetched idea; take the Japanese health-care system for example. Based on the requirement that all citizens are required to have health insurance, the Ministry of Health negotiates with physicians to set prices for every procedure, which keeps costs down. Therefore, health care providers (e.g., hospitals, doctors, etc) have no control over what they charge patients. To attract patients and stay in business, providers compete on one factor – the quality of care received. If patients are not satisfied with the doctor’s practice, then they can easily go to another. Interestingly, the providers can face bankruptcy – not the patient like her in the U.S. – if they don’t maintain a certain number of patients.

Overall with the amount of data provided, the book details the issues with the U.S. health care system. It’s apparent that health care reform is a must and should be achieved with the patient’s interest in mind and not that of the industry.

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Today, the Public Health Bugle and many other health organizations, media outlets, academic institutions attended a conference call to launch this years “Health Country Rankings.” Below is the press release explaining what these rankings are and how they affect us all. I will publish the recording of today’s conference call answer/question session in the near future. Also, HERE was last year’s exclusive interview.

--Healthiest and Least Healthy Counties Ranked in Every State–

(source: County Health Rankings, the Robert Wood Johnson Foundation, and the University of Wisconsin)

2012 County Health Rankings Show What Influences How Healthy Residents Are, How Long They Live

 Madison, WI and Princeton, NJ (April 3, 2012) – More than 3,000 counties and the District of Columbia can compare how healthy their residents are and how long they live with the 2012 County Health Rankings, released today. The Rankings are an annual check-up that highlights the healthiest and least healthy counties in every state, as well as those factors that influence health, outside of the doctor’s office. The Rankings highlight the importance of critical factors such as education rates, income levels, and access to healthy foods, as well as access to medical care, in influencing how long and how well people live. Now in their third year, the Rankings are increasingly being used by community leaders to help them identify challenges and take action in a variety of ways to improve residents’ health.

Published on-line at www.countyhealthrankings.org by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation (RWJF), the Rankings assess the overall health of nearly every county in all 50 states, using a standard way to measure how healthy people are and how long they live. The Rankings consider factors that affect people’s health within four categories: health behavior, clinical care, social and economic factors, and physical environment. This year’s Rankings include several new measures, such as how many fast food restaurants are in a county and levels of physical inactivity among residents. Graphs illustrating premature death trends over 10 years are new as well.

“The County Health Rankings show us that much of what influences our health happens outside of the doctor’s office. In fact, where we live, learn, work and play has a big role in determining how healthy we are and how long we live,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of RWJF. “The good news is that businesses, health care providers, government, consumers and community leaders are already joining forces in communities across the nation to change some of the gaps that the Rankings highlight.”

The Rankings show that, within states and across the nation, there are big differences in health and the factors that influence health.

Within each state, even the healthiest counties have areas where they can improve. Healthier counties (those where people live longer and have a better quality of life) have lower rates of smoking, physical inactivity, teen births, preventable hospital stays, unemployment, children in poverty, and violent crime and higher levels of education, social support, and access to primary care physicians. But healthier counties are no more likely than unhealthy counties to have lower rates of excessive drinking or obesity or better access to healthy food options.

Across the nation, some factors that influence health, such as smoking, availability of primary care physicians, and social support, show highs and lows across all regions. Meanwhile other factors reflect some distinct regional patterns, such as:

• Excessive drinking rates are highest in the northern states.
• Rates of teen births, sexually transmitted infections, and children in poverty are highest across the southern states.
• Unemployment rates are lowest in the northeastern, Midwest, and central plains states.
• Motor vehicle crash deaths are lowest in the northeastern and upper Midwest states.

The Rankings are based on the latest publicly-available data for each county and are unique local tools that every county can use to measure where its residents stand on multiple factors that influence health compared to other counties in their state. Residents also can see how their county measures up on indicators like diabetes screening by comparing their county’s rank against a national benchmark reflecting the top performing counties in the United States. This year, the Rankings are easier to use than ever, with a new interactive mapping feature available at www.countyhealthrankings.org.

Since the first launch of the Rankings in 2010, a number of communities including Wyandotte, Kan.; Hernando, Miss., and the Joy-Southfield neighborhood in Detroit, have taken steps to address some of the health gaps identified by the Rankings.

“After three years, we’ve learned that people across the entire nation want to know how the health of their county compares to others in their state. This annual check-up helps bring county leaders together to see where they need to improve,” said Patrick Remington, M.D., M.P.H., professor and associate dean at the University of Wisconsin School of Medicine and Public Health. “It’s really exciting to see that the Rankings continue to serve as a call to action to take steps to improve the health of communities.”

The County Health Rankings can help us learn more about what’s making people sick or healthy. New this year, the County Health Roadmaps will help counties to mobilize and take action to create healthier places. To learn what other communities are doing to improve the health of their residents and how your county can develop plans to address health challenges, visit http://www.countyhealthrankings.org/roadmaps.

Today also marks the release of the call for applications for the Roadmaps to Health Prize, another component of the County Health Roadmaps project that recognizes and honors the efforts and accomplishments of communities in the U.S. working at the forefront of better health for all residents. Up to six Roadmaps to Health Prize winning communities will be honored in early 2013 and each will receive a no-strings-attached $25,000 cash prize. Find out more and apply at www.countyhealthroadmaps.org/prize.

To further illustrate the connection between social factors and health, RWJF along with the Virginia Commonwealth University’s Center on Human Needs today unveiled a new County Health Calculator (www.countyhealthcalculator.org). The Calculator is an interactive online app that shows people how much education and income influence rates of diabetes and spending on diabetes care county-by-county.

For more information, visit www.countyhealthrankings.org. Since the site’s launch in 2010, more than 1 million advocates, policymakers and concerned citizens have visited to learn where their county ranks and how they can take action to improve health.

Follow the County Health Rankings on Twitter (@CHRankings) or Facebook, and join the conversation by using #healthrankings.

 About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

About the University of Wisconsin Population Health Institute

The University of Wisconsin Population Health Institute is the focal point within the University of Wisconsin School of Medicine and Public Health for translating public health and health policy research into practice. The Institute strives to:

• Address a broad range of real-world problems of topical importance to government, business, providers and the public;
• Promote partnerships of inquiry between researchers and users of research, breaking down barriers between the academic community and public and private sector policy makers; and
• Make useful contributions to public health and health policy decisions that improve the health of the public.

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